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Alghamdi A, Alghamdi EA, Alghamdi A, Abusayf MM, Ahad MA. Successful Collagen Crosslinking in a Patient With Keratoconus and Systemic Scleroderma. Cureus 2024; 16:e59431. [PMID: 38826919 PMCID: PMC11140440 DOI: 10.7759/cureus.59431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 06/04/2024] Open
Abstract
Scleroderma is an autoimmune disease that affects connective tissue. Keratoconus (KC) is a rare ocular condition that may appear alongside scleroderma. Contact lenses are an essential visual aid for KC patients, especially in advanced cases. However, scleroderma patients may face difficulties using them due to finger-related disabilities. Corneal collagen cross-linking (CXL) is a crucial treatment used to prevent corneal thinning and visual deterioration in progressive KC. However, the potential trigger of corneal melt and delayed healing following CXL in KC patients with scleroderma is a matter of concern. We present a case of a patient with KC and scleroderma who underwent CXL without any complications.
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Affiliation(s)
- Ayman Alghamdi
- Oculoplastic Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
| | | | - Abdullah Alghamdi
- Community Medicine, King Abdulaziz University Faculty of Medicine, Jeddah, SAU
| | | | - Muhammad A Ahad
- Cornea and External Disease Division, King Khaled Eye Specialist Hospital, Riyadh, SAU
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Saad A, Narr J, Frings A, Steinberg J, Katz T, Linke SJ. Surgical outcomes of laser in situ keratomileusis (LASIK) in patients with stable systemic disease. Int Ophthalmol 2024; 44:119. [PMID: 38418603 PMCID: PMC10902021 DOI: 10.1007/s10792-024-02956-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/04/2023] [Indexed: 03/01/2024]
Abstract
PURPOSE To evaluate the surgical outcome in terms of safety, efficacy, predictability, and retreatment rate of LASIK surgery in patients with controlled systemic diseases in comparison with healthy individuals. METHODS The retrospective study included data from 1936 eyes of 976 patients with stable systemic diseases who underwent LASIK surgery between January 2016 and June 2019. The safety, efficacy, predictability of the surgery, and retreatment rate were evaluated in comparison with a control group comprising 1951 patients. The study was approved by the local ethics committee and adhered to the principles of the Declaration of Helsinki. Statistical analysis was performed using R team and the level of statistical significance was set at p < 0.05. RESULTS All treatment groups demonstrated high safety and efficacy indices after LASIK surgery. Furthermore, the study arms demonstrated comparable predictability and retreatment rates to the control group in nearly all cases. Retreatment rates were significantly higher in the rheumatoid arthritis group (p = 0.03), while safety indices were significantly lower in the hay fever group compared to the control group (p = 0.004). No intra- or postoperative sight-threatening complications were documented. CONCLUSION Our findings suggest that selected patients with stable systemic conditions can safely undergo LASIK surgery and achieve comparable outcomes to healthy individuals. Further research is needed to better understand the treatment outcomes in this challenging patient population.
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Affiliation(s)
- Amr Saad
- Department of Ophthalmology, Heinrich-Heine University, Duesseldorf, Germany
| | - Jenny Narr
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
| | - Andreas Frings
- Department of Ophthalmology, Heinrich-Heine University, Duesseldorf, Germany.
- Augenheilkunde & Augenlaser Zentrum PD Dr. med. A. Frings, Nuremberg, Germany.
| | - Johannes Steinberg
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
| | - Toam Katz
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Care-Vision, Hamburg, Germany
| | - Stephan Johannes Linke
- Department of Ophthalmology, University Medical Center, Hamburg, Germany
- Zentrum Sehstärke, Hamburg, Germany
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Ortega-Usobiaga J, Rocha-de-Lossada C, Llovet-Rausell A, Llovet-Osuna F. Update on contraindications in laser corneal refractive surgery. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:105-111. [PMID: 36114139 DOI: 10.1016/j.oftale.2022.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 07/15/2022] [Indexed: 02/07/2023]
Abstract
More than 25 years of experience with refractive surgery techniques (since the FDA [Food and Drug Administration] of the United States approved the use of the excimer laser in the remodeling of the cornea in 1995), added to the technological advances in ophthalmology (femtosecond laser, topography-guided ablation, anterior segment imaging systems) and increased understanding of refractive errors, higher order aberrations, and corneal biomechanics make corneal laser refractive surgery a safe method and effective for the correction of these defects. However, to date, there are still certain circumstances that represent a contraindication for its application, in addition to others that could be associated with complications, and that must be carefully analyzed. This review analyzes the current contraindications for laser corneal refractive surgery listed in the Preferred Practice Protocols (PPPs) of the American Academy of Ophthalmology and the Spanish Ophthalmology Society. These protocols are based on the best scientific evidence currently available and allow clear recommendations to be drawn, improving the safety profile of these techniques. Contraindications can be differentiated into relative or absolute; among the latter are: age less than 18 years, the absence of refractive stability and the existence of certain ocular pathologies (including certain corneal dystrophies, keratoconus, poorly controlled dry eye) or systemic pathologies (active autoimmune processes or poorly controlled diabetes mellitus). Other circumstances such as the use of certain drugs (amiodarone, isotretinoin), extreme values of mean central keratometry and pachymetry, history of previous uveitis or glaucoma, pregnancy and lactation, are considered relative contraindications according to the PPPs. However, there are studies that demonstrate the safety of refractive surgery in some of these cases.
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Affiliation(s)
- J Ortega-Usobiaga
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera (Aier Eye Hospital Group), Bilbao, Vizcaya, Spain.
| | - C Rocha-de-Lossada
- Departamento de Oftalmología, Hospital Virgen de las Nieves, Granada, Spain; Departamento de Oftalmología (Qvision), Hospital Vithas, Almería, Spain; Departamento de Cirugía, Universidad de Sevilla, Sevilla, Spain
| | - A Llovet-Rausell
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera (Aier Eye Hospital Group), Valencia, Spain; Servicio de Oftalmología, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - F Llovet-Osuna
- Departamento de Catarata y Cirugía Refractiva, Clínica Baviera (Aier Eye Hospital Group), Valencia, Spain; Facultad de Medicina, Ciencias de la Salud, Universidad Cardenal Herrera - CEU, Valencia, Spain
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Abstract
PURPOSE OF REVIEW Autoimmune and immune-mediated diseases are considered contraindications for laser refractive surgeries according to the US Food and Drug Administration's guideline. This guideline, however, is based on limited case reports or complications reported during other intraocular procedures. There have been only a handful of new clinical studies that evaluate the efficacy and safety of refractive surgery in this specific patient population. The aim of this article is to review currently available research and offer updated recommendations for the evaluation and management of laser refractive surgery (LRS) in patients with autoimmune diseases. RECENT FINDINGS More recent retrospective studies have reported good refractive outcomes in patients with well controlled autoimmune diseases such as rheumatoid arthritis, systemic lupus erythematosus, seronegative spondyloarthropathy, among others. No severe sight-threatening complications have been reported in these reports. Although postoperative complications occur, the risk of refractive surgery is comparable with those without autoimmune diseases. SUMMARY With the exception of primary Sjogren's syndrome, patients with autoimmune diseases may be good candidates for LRS if diseases are well controlled and have minimal ophthalmic manifestation. Patients should be made aware of the potential surgical complications and be informed of the currently available data. More multicenter and larger prospective studies are needed to compare the refractive outcomes and surgical complications in patients with and without autoimmune diseases. This will help patients make better informed medical decisions.
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Czompa L, Barta Z, Ziad H, Nemeth G, Rentka A, Aszalos Z, Zold E, Gesztelyi R, Zsuga J, Szodoray P, Kemeny-Beke A. Corneal Manifestations of Inflammatory Bowel Disease. Semin Ophthalmol 2019; 34:543-550. [PMID: 31657260 DOI: 10.1080/08820538.2019.1684525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Purpose: To evaluate detailed corneal parameters of inflammatory bowel disease (IBD) patients, including Crohn's disease (CD) and ulcerative colitis (UC) patients, and to assess associations between anterior segment values and other clinical variables.Methods: This prospective cross-sectional case-control study at a tertiary referral center included 30 CD patients, 36 UC patients and 80 age- and gender-matched controls with no ocular symptoms or ocular surface disorders. All study participants underwent a comprehensive ophthalmological evaluation with special interest in dry eye disease (DED). Corneal parameters were evaluated by Pentacam.Results: The mean age of CD patients, UC patients, and controls was 45.80 ± 11.55 years, 52.00 ± 16.05, and 50.68 ± 14.62, respectively. The average disease duration was 12.72 ± 5.83 years for CD patients and 15.94 ± 10.09 years for UC patients. All pachymetric (center, apex and thinnest) and corneal volume (CV) measurements were significantly decreased, while anterior chamber angle width (ACA) values were significantly increased on both sides in all IBD patients compared to those in controls (p < .05). In addition, several anterior segment parameters were altered unilaterally in CD or UC patients. Negative correlations were found between corneal parameters and Schirmer I test values.Conclusions: Our investigations suggest that IBD patients have thinner corneas compared to that of controls. The coexistence of reduced tear quantity seems to have an additional impact on the thinning of the cornea in IBD patients. Early recognition of corneal impairments, a possible extraintestinal manifestation of IBD, should be included in the disease checkup to reduce vision-threatening developments.
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Affiliation(s)
- Levente Czompa
- Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, University of Debrecen, Debrecen, Hungary
| | - Zsolt Barta
- Department of Gastroenterology, Institute of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Infectology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Hassan Ziad
- Orbi-Dent Refractive Surgery and Medical Center, Debrecen, Hungary
| | - Gabor Nemeth
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
- Department of Ophthalmology, Borsod-Abauj-Zemplen County Hospital and University Teaching Hospital, Miskolc, Hungary
| | - Aniko Rentka
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Zsuzsa Aszalos
- Department of Immunology, Institute of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Eva Zold
- Department of Immunology, Institute of Medicine, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Peter Szodoray
- Institute of Immunology, Rikshospitalet, Oslo University Hospital, Oslo, Norway
| | - Adam Kemeny-Beke
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Evaluation of Objective Signs and Subjective Symptoms of Dry Eye Disease in Patients with Inflammatory Bowel Disease. BIOMED RESEARCH INTERNATIONAL 2019; 2019:8310583. [PMID: 30729131 PMCID: PMC6341274 DOI: 10.1155/2019/8310583] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 12/20/2018] [Indexed: 12/30/2022]
Abstract
Aim To evaluate tear film parameters and relationship of objective clinical signs and subjective symptoms of dry eye disease (DED) in inflammatory bowel disease (IBD) subgroups. Methods 39 patients with Crohn's disease (CD), 26 patients with ulcerative colitis (UC), and 39 control persons with no ocular symptoms or surface disorders were included in this prospective, case-control, and cross-sectional study. The ocular surface disease index (OSDI) questionnaire was applied to evaluate dry eye symptoms, and objective tests of DED were performed on both eyes of each subject. Results The average of OSDI scores was 30.59 (±16.68) in CD patients, 24.67 (±23.48) in UC patients, and 11.19 (±5.8) in controls. Except for tear film breakup time (tBUT) and Schirmer-I values other objective parameters were better in UC patients, than in CD patients. CD patients rather than UC patients tend to develop DED. This was associated with immunosuppressant and TNF-α inhibitor use. Conclusions Clinicians must be aware of the spectrum of DED involvement in IBD and suggest using artificial tears in order to decrease severity of ocular complications.
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[Corneal refractive surgery despite systemic diseases?]. Ophthalmologe 2019; 116:677-681. [PMID: 30684006 DOI: 10.1007/s00347-019-0852-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
According to the literature there are a large number of potential systemic contraindications for corneal refractive surgery. In cases with relative contraindications, surgery should be performed only after weighing up the individual risks and under controlled disease conditions; however, the "evidence" for many of these contraindications is based only on case reports or series, expert opinions or known complications in non-laser-assisted eye surgery. Randomized clinical trials are therefore required.
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Outcomes and complications of excimer laser surgery in patients with collagen vascular and other immune-mediated inflammatory diseases. J Cataract Refract Surg 2018; 42:1742-1752. [PMID: 28007105 DOI: 10.1016/j.jcrs.2016.09.018] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2016] [Revised: 08/31/2016] [Accepted: 09/23/2016] [Indexed: 11/21/2022]
Abstract
PURPOSE To assess refractive and visual outcomes and postoperative complications in a large number of patients with well-controlled collagen vascular and other immune-mediated inflammatory diseases. SETTING Optical Express, Glasgow, United Kingdom. DESIGN Retrospective case series. METHODS The files were reviewed of patients who had collagen vascular and other immune-mediated inflammatory diseases and who had excimer laser surgery between 2008 and 2015. In all cases, the disease was well controlled with no flare or symptoms for a minimum of 6 months preoperatively. RESULTS The study comprised 622 patients (1224 eyes) with 1 of the following underlying diseases: rheumatoid arthritis (50.6% of patients), systemic lupus erythematosus (19.5%), psoriatic arthritis (10.5%), sarcoidosis (10.0%), ankylosing spondylitis (6.4%), multiple sclerosis (1.9%), or scleroderma (1.1%). Laser in situ keratomileusis (LASIK) was performed in 1114 eyes (91.0%) and photorefractive keratectomy (PRK) in 110 eyes (9.0%). The mean follow-up was 10.9 months. The preoperative spherical equivalent ranged between -10.13 diopters (D) and +4.13 D (LASIK) and -9.50 D and +4.00 D (PRK). Postoperatively, 81.8% LASIK eyes and 82.3% PRK eyes were within ±0.50 D. The uncorrected distance visual acuity was 20/20 or better in 76.8% and 73.4%, respectively. Complications were mostly those that would be expected after excimer laser surgery in a population of patients without disease with the exception of 1 peripheral flap melt that responded to treatment with topical steroids. CONCLUSION Excimer laser surgery can be safely performed in patients with well-controlled collagen vascular or other immune-mediated inflammatory disease. FINANCIAL DISCLOSURE Dr. S.C. Schallhorn is a consultant to Abbott Medical Optics, Inc., Acufocus, Inc., and Carl Zeiss Meditec AG, and a global medical director for Optical Express. No other author has a financial or proprietary interest in any material or method mentioned.
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Nagy A, Rentka A, Nemeth G, Ziad H, Szücs G, Szekanecz Z, Gesztelyi R, Zsuga J, Aszalos Z, Szodoray P, Kemeny-Beke A. Corneal Manifestations of Systemic Sclerosis. Ocul Immunol Inflamm 2018; 27:968-977. [PMID: 30015530 DOI: 10.1080/09273948.2018.1489556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose: Corneal involvement in systemic sclerosis (SSc) is rare, but due to rich collagen composition cornea is especially vulnerable to connective tissue diseases. Therefore, our aim was to evaluate corneal parameters of SSc patients. Methods: The study included 32 SSc patients and 39 control subjects with no ocular symptoms or ocular surface disorders. All study participants underwent Pentacam evaluation and objective signs of dry eye disease (DED), and clinical parameters were evaluated. Results: All pachymetric values, most of the corneal front surface, corneal volume, as well as anterior chamber depth measurements were significantly lower in the SSc group than in the control group (p < 0.05). Significant negative correlation was found between corneal parameters and age on the one hand, and disease duration on the other. Conclusions: Early recognition of corneal impairment, a possible extraintestinal manifestation of SSc, should be included in the check-up of the disease in order to reduce sight-threatening complications.
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Affiliation(s)
- Annamaria Nagy
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Aniko Rentka
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Gabor Nemeth
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen , Debrecen , Hungary.,Department of Ophthalmology, Borsod-Abauj-Zemplen County Hospital and University Teaching Hospital , Miskolc , Hungary
| | - Hassan Ziad
- Orbi-Dent Refractive Surgery and Medical Centre , Debrecen , Hungary
| | - Gabriella Szücs
- Department of Rheumatology, Institute of Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Zoltán Szekanecz
- Department of Rheumatology, Institute of Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Rudolf Gesztelyi
- Department of Pharmacology and Pharmacotherapy, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Judit Zsuga
- Department of Health Systems Management and Quality Management in Health Care, Faculty of Public Health, University of Debrecen , Debrecen , Hungary
| | - Zsuzsa Aszalos
- Department of Immunology, Institute of Medicine, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
| | - Peter Szodoray
- Institute of Immunology, Rikshospitalet, Oslo University Hospital , Oslo , Norway
| | - Adam Kemeny-Beke
- Department of Ophthalmology, Faculty of Medicine, University of Debrecen , Debrecen , Hungary
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Abstract
Corneal involvement in patients with systemic inflammatory disorders may be sight threatening, and it may be associated with a life-threatening disease. Significant systemic inflammatory diseases in this context are autoimmune connective tissue diseases, systemic autoimmune dermatological disorders, and autoimmune diseases of the lacrimal system. Keratoconjunctivitis sicca is usually the most common ocular finding in these patients. Peripheral ulcerative keratitis is a rare condition usually associated with increased ocular morbidity and also mortality, as it might act as an indicator of a more widespread vasculitis. Corneal biomechanical properties may also be altered in connective tissue diseases. Although recent studies suggest that the risk for corneal complications after ocular surgery in patients with quiescent autoimmune disease is minimal, caution is still recommended, as the knowledge about the corneal wound-healing process and the corneal biomechanical properties in these patients is not yet fully understood. This article reviews corneal abnormalities and characteristics in the setting of systemic inflammatory diseases.
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Burkholder BM, Kuo IC. Peripheral Ulcerative Keratitis following Laser in situ Keratomileusis. Case Rep Ophthalmol 2016; 7:9-15. [PMID: 26889153 PMCID: PMC4748760 DOI: 10.1159/000443324] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Purpose We report a case of a patient with a history of glomerulonephropathy, not disclosed prior to laser in situ keratomileusis (LASIK), who developed severe postoperative peripheral ulcerative keratitis (PUK) soon after surgery. Method Case report. Results Within a week of surgery, the patient, who had no blepharitis or ocular surface disease, also developed diffuse lamellar keratitis (DLK) that was not contiguous with the PUK. Microbiologic evaluation of the flap interface disclosed no organisms, and no epithelial ingrowth was found. Both PUK and DLK resolved with topical and oral steroid therapy, and the patient's induced refractive error improved over the 12 months following LASIK. Conclusions Necrotizing keratitis has been described after LASIK surgery in patients with or without autoimmune disease. However, to our knowledge, there has been no case of PUK following LASIK. As shown by our patient's clinical course and the typical association of PUK with systemic conditions, patients with a history of atypical postinfectious sequelae may require additional preoperative counseling, vigilant postoperative monitoring, and possibly additional intervention. Because patients do not always divulge medical details, especially if an extraocular site was involved or illness occurred many years prior, this case demonstrates the importance of performing a diligent history that excludes autoimmune disorders or atypical postinfectious sequelae prior to proceeding with keratorefractive intervention.
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Affiliation(s)
- Bryn M Burkholder
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Md., USA
| | - Irene C Kuo
- Wilmer Eye Institute, Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Md., USA
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Update on contraindications for laser-assisted in situ keratomileusis and photorefractive keratectomy. Curr Opin Ophthalmol 2014; 25:251-7. [DOI: 10.1097/icu.0000000000000055] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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AlKharashi M, Bower KS, Stark WJ, Daoud YJ. Refractive surgery in systemic and autoimmune disease. Middle East Afr J Ophthalmol 2014; 21:18-24. [PMID: 24669141 PMCID: PMC3959036 DOI: 10.4103/0974-9233.124082] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
Patients with underlying systemic disease represent challenging treatment dilemma to the refractive surgeon. The refractive error in this patient population is accompanied by a systemic disease that may have an ocular or even a corneal component. The literature is rather sparse about the use of laser refractive surgery (LRS) and such procedure is not approved by the United States Food and Drug Administration (FDA) in this patient population. Patients with collagen vascular disease, diabetes mellitus (DM), allergic and atopic disease, or human immunodeficiency virus (HIV) are never ideal for LRS. Patients with uncontrolled systemic disease or ocular involvement of the disease should not undergo LRS. However, a patient with well-controlled and mild disease, no ocular involvement, and not on multidrug regimen may be a suitable candidate if they meet stringent criteria. There is a need for a large, multicenter, controlled trial to address the safety and efficacy of LRS in patients with systemic disease before such technology can be widely adopted by the refractive surgery community.
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Affiliation(s)
- Majed AlKharashi
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Kraig S Bower
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Walter J Stark
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
| | - Yassine J Daoud
- The Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland, USA
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Abstract
Laser-assisted in situ keratomileusis (LASIK) is a frequently performed corneal refractive surgery with excellent refractive outcomes. The most common complication of LASIK is dry eyes, with virtually all patients developing some degree of dryness in the immediate postoperative period. Identifying preoperative dry eyes, and conscientious attention and treatment in the perioperative time period, can lead to enhanced patient satisfaction and more accurate visual outcomes. Improved understanding of the development of dry eyes after LASIK will advance our understanding of the complex pathophysiology of dry eye disease.
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Affiliation(s)
- Roni M Shtein
- Department of Ophthalmology and Visual Sciences, University of Michigan, Kellogg Eye Center, 1000 Wall Street, Ann Arbor, MI 48105, USA, Tel.: +1 734 763 5506
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Ortak H, İnanır A, Demir S, Uysal A, Şahin Ş, Sağcan M, Önder Y, Alim S, Demir AK. Decreased central corneal thickness in ankylosing spondylitis. Int Ophthalmol 2013; 34:263-8. [DOI: 10.1007/s10792-013-9827-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 07/03/2013] [Indexed: 10/26/2022]
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Simpson RG, Moshirfar M, Edmonds JN, Christiansen SM, Behunin N. Laser in situ keratomileusis in patients with collagen vascular disease: a review of the literature. Clin Ophthalmol 2012; 6:1827-37. [PMID: 23152662 PMCID: PMC3497460 DOI: 10.2147/opth.s36690] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
PURPOSE To evaluate the current United States Food and Drug Administration (FDA) recommendations regarding laser in situ keratomileusis (LASIK) surgery in patients with collagen vascular diseases (CVD) and assess whether these patients make appropriate candidates for laser vision correction, and offer treatment recommendations based on identified clinical data. METHODS A literature search was conducted using PubMed, Medline, and Ovid to identify all existing studies of LASIK in patients with collagen vascular diseases. The search was conducted without date limitations. Keywords used for the search included MeSH terms: laser in situ keratomileusis, LASIK, refractive surgery, ocular surgery, and cataract surgery connected by "and" with the following MeSH and natural-language terms: collagen vascular disease, rheumatic disease, systemic disease, rheumatoid arthritis, systemic lupus erythematosus, Sjögren's syndrome, seronegative spondyloarthropathy, HLA B27, ankylosing spondylitis, reactive arthritis, psoriatic arthritis. The abstracts for all studies meeting initial search criteria were reviewed; relevant studies were included. No prospective studies were found; however, four retrospective case studies were identified that examined LASIK surgery in patients with CVD. Several case reports were also identified in similar fashion. RESULTS The FDA considers CVD a relative contraindication to LASIK surgery, due largely to the ocular complications associated with disease in the CVD spectrum. However, recent studies of LASIK in patients with CVD indicate LASIK may be safe for patients with very well-controlled systemic disease, minimal ocular manifestations, and no clinical signs or history of dry-eye symptoms. CONCLUSION LASIK surgery may be safe in patients with rheumatoid arthritis or systemic lupus erythematosus and the seronegative spondyloarthropathies if stringent preoperative criteria are met. Evidence suggests patients with Sjögren's syndrome are not suitable candidates for LASIK.
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Aman-Ullah M, Gimbel HV, Purba MK, van Westenbrugge JA. Necrotizing keratitis after laser refractive surgery in patients with inactive inflammatory bowel disease. Case Rep Ophthalmol 2012; 3:54-60. [PMID: 22611369 PMCID: PMC3355644 DOI: 10.1159/000336567] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Two cases of necrotizing keratitis following laser refractive corneal surgery, with stable and controlled Crohn's disease are described. A 40-year-old woman developed bilateral stromal inflammation and inferior thinning in the right eye along the flap edge within 1 day of uneventful bilateral IntraLase laser-assisted in situ keratomileusis. The other case is a 30-year-old man who also developed bilateral inferior stromal infiltrates 2 days following photorefractive keratectomy. Both cases were aggressively treated with systemic and topical corticosteroids. The infiltrates in both patients gradually resolved, with one relapse during the 7 months period of follow-up in the first case. These cases highlight the importance of taking precautions considering this and similar autoimmune conditions as a relative contraindication to refractive surgery.
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Abstract
PURPOSE OF REVIEW Hyperosmolarity is a central mechanism causing ocular surface inflammation and eye irritation in typical patients suffering from tear dysfunction. Tear composition in dry eyes, or dysfunctional tear syndrome, may destabilize the tear film and cause ocular surface epithelial disease. Increased activity of matrix metalloproteinases (MMPs), especially MMP-9, plays a critical role in wound healing and inflammation and is primarily responsible for the pathologic alterations to the ocular surface that leads to a dysfunctional tear state. RECENT FINDINGS Altered corneal epithelial barrier function is the cause for ocular irritation and visual morbidity in dry eye disease. The increased MMP-9 activity in dry eyes may contribute to deranged corneal epithelial barrier function, increased corneal epithelial desquamation, and corneal surface irregularity. SUMMARY Dry eye is one of the most common complications of photorefractive keratectomy and laser in-situ keratomileusis (LASIK). LASIK has both a neurotrophic effect on the cornea and leads to a physical change in corneal shape that results in a change in tear dynamics, leading to ocular surface desiccation. The reduction in tear function after LASIK may induce an increase in osmolarity and consequently raise the concentration of proinflammatory cytokines and MMP-9 in the tear film, which results in dry eyes and insufficient attachment between the corneal flap and the corneal bed. Appropriate diagnosis and management of dysfunctional tear syndrome may lead to less postoperative LASIK complications.
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Patient Evaluation and Selection in Refractive Surgery. Cornea 2011. [DOI: 10.1016/b978-0-323-06387-6.00166-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Rodriguez-Prats JL, Morbelli H, Rodriguez-Chan JM, Alió JL. Psoriatic intraepithelial keratitis after laser in situ keratomileusis treatment. J Cataract Refract Surg 2010; 37:194-7. [PMID: 21093214 DOI: 10.1016/j.jcrs.2010.10.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2010] [Revised: 08/26/2010] [Accepted: 08/30/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED A 36-year-old woman with chronic psoriasis developed blurring of vision and intraepithelial infiltrates within the flap in the left eye concurrent with the appearance of acute psoriatic generalized skin lesions 14 days after bilateral laser in situ keratomileusis. After treatment with topical antibiotic and steroid agents and topical artificial tears, the intraepithelial infiltrates within the flap completely resolved. The final uncorrected distance visual acuity was 1.0 in both eyes, along with complete resolution of the dermatologic psoriatic lesions. FINANCIAL DISCLOSURE No author has a financial or proprietary interest in any material or method mentioned.
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Sierra Wilkinson P, Davis EA, Hardten DR. LASIK. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00019-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Young JA, Kornmehl EW. Preoperative Evaluation for Refractive Surgery. Ophthalmology 2009. [DOI: 10.1016/b978-0-323-04332-8.00016-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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LASIK-associated Dry Eye and Neurotrophic Epitheliopathy: Pathophysiology and Strategies for Prevention and Treatment. J Refract Surg 2008; 24:396-407. [DOI: 10.3928/1081597x-20080401-14] [Citation(s) in RCA: 160] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Cobo-Soriano R, Beltrán J, Baviera J. Author reply. Ophthalmology 2007. [DOI: 10.1016/j.ophtha.2007.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kohnen T. Reply : Excimer laser refractive surgery in patients with underlying autoimmune diseases. J Cataract Refract Surg 2007. [DOI: 10.1016/j.jcrs.2006.10.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Cobo-Soriano R, Beltrán J, Baviera J. LASIK outcomes in patients with underlying systemic contraindications: a preliminary study. Ophthalmology 2006; 113:1118.e1-8. [PMID: 16647130 DOI: 10.1016/j.ophtha.2006.02.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2005] [Revised: 02/19/2006] [Accepted: 02/20/2006] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To determine the anatomic and functional outcomes of photorefractive surgery in patients with underlying systemic diseases that are traditionally listed as relative or absolute contraindications. DESIGN Observational retrospective case-control study. PARTICIPANTS The case groups were composed of 275 eyes of 141 consecutive patients who underwent a LASIK procedure with any of the following underlying conditions: autoimmune connective-tissue disorders (n = 62), psoriasis (n = 91), intestinal inflammatory diseases (n = 67), diabetes mellitus (n = 44), and history of keloid formation (n = 18). Twenty-nine patients (56 eyes) were receiving systemic immunosuppressive therapy. The control group comprised 358 eyes of 181 patients without the above-mentioned conditions who underwent LASIK. METHODS The study had 2 parts, relating to the anatomic and functional (visual and refractive) outcomes. For anatomic outcome, we compared the entire sample of both groups. For functional outcome, only myopic eyes of each group were compared. Independent comparisons were performed between each disease group and the control group. MAIN OUTCOME MEASURES Anatomic outcomes included perioperative and postoperative epithelial, flap, and interface complications. Functional outcomes were evaluated using visual and refractive indicators, percentage of eyes undergoing enhancement, and number of postoperative visits. RESULTS Mild anatomic complications were observed in the case and control groups with similar percentages, and there were no statistical differences between groups. Regarding functional outcome, the only significant finding was a worse refractive outcome in the collagen vascular diseases group compared with controls. There were no other statistical differences detected in the other systemic disease groups. CONCLUSIONS In our experience, LASIK can be performed effectively and safely in selected patients with stable and controlled systemic diseases with favorable postoperative anatomic and visual outcomes. The absolute exclusion of certain systemic contraindications should be reconsidered.
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